Healthcare Provider Details

I. General information

NPI: 1740280197
Provider Name (Legal Business Name): MICHAEL STEPHEN WEINSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5730 GLENRIDGE DR SUITE 300
ATLANTA GA
30328-6141
US

IV. Provider business mailing address

PO BOX 420858
ATLANTA GA
30342-0858
US

V. Phone/Fax

Practice location:
  • Phone: 404-250-1153
  • Fax: 404-303-0317
Mailing address:
  • Phone: 404-250-1153
  • Fax: 404-303-0317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number033485
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number33485
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: